Project Summary This classic phase II trial was designed to help with a clinical problem which has appeared with patients with Adrenocortical Carcinoma (ACC). With the increase of laparoscopy, there has been an increase in patients presenting with the first sign of metastatic ACC being intraperitoneal spread. Classically, peritoneal carcinomatosis is difficult to treat with either surgery of chemotherapy alone. This trial combines the NCI experience of cytoreductive surgery and intraperitoneal heated chemotherapy, in order to tackle this difficult clinical scenario. The project is new and just opened to accrual and although it is a rare histology, we have enrolled our first patient. Our goals for this trial are multiple including understanding the impact of this locoregional therapy on patients in this clinical conundrum. In addition, we expect to define the morbidity, impact on quality of life, examine patterns of recurrence and lastly to explore molecular analysis to try to determine the difference between surface metastasis and organ metastasis. With international experts in the field, this will be a great intramural collaboration.